The United States Preventive Services Task Force recommends against screening for asymptomatic carotid artery stenosis in the general adult population, according to a recommendation statement being published in Annals of Internal Medicine.
Stroke is a leading cause of death and disability in the United States and having carotid artery stenosis (a buildup of plaque in the carotid arteries that causes them to narrow) is a risk factor. although it accounts for a smaller number of strokes than the major risk factors hypertension, diabetes and hyperlipidemia. Ultrasonography is the most convenient and non-invasive screening test for carotid artery stenosis, but it is associated with a high rate of false positive results. Researchers conducted a systematic review of 56 published studies and found no evidence of a benefit for screening for carotid artery stenosis in the general population, but did find a small to moderate risk for harms, such as stroke, myocardial infarction, and mortality with the interventions that may follow positive screening results. The severity of harms depended on patient population, surgeon, center volume, and geographic location. This update reconfirms the Task Force's 2007 recommendation on screening for carotid artery stenosis.
The authors of an accompanying editorial write that although the data clearly support the USPSTF recommendation against population screening, these types of screenings are still offered to the public at fairs and other settings. They suggest that physician specialty society initiatives (e.g. Choosing Wisely from the American Board of Internal Medicine and High Value Care from the American College of Physicians) strengthen their messaging so that potential consumers of these services are aware that the test is unlikely to prevent them from having a stroke or lead to improvements in their health.